streetstoriesems

The career archive of a NYC paramedic

Tag: emt stories

Pork Chops au Revoir

January 2, 2021 /

Eugene was a urinator. Without fail, whenever we picked up our homeless regular from the underpass of the West Side Highway, he was sure to use our ambulance as his own personal toilet. It was no accident, no failure of bladder control due to illness. We had taken him to numerous ERs, where whatever condition he might have had, could have been treated. But Eugene admitted that he had nothing medical that precluded him from marking his territory like a feral cat. Eugene was proud of his urinary control and told us he made sure to pee on every societal institution he came in contact with. On top of being a urinator, he was also a cantankerous and angry man. He used abusive language, particularly to me as a woman who, he felt, should have no issue cleaning things, as it was something women were just supposed to do. Regardless of how much we begged him to relieve himself elsewhere, he was sure to reserve a portion of his liquid waste for the door or the step-well or some other corner of the tiny space we called our workplace. He was very matter-of-fact about it and told us we should be grateful it was just urine.

Our ambulance is our home for eight hours, five days a week and we needed to have some control over our environment given that our other places of work-the street, peoples homes, offices, everywhere else really, were unpredictable. We liked our familiar truck, with its arbitrary intercom system and it’s non functioning, first generation computer terminal, which was promised to be on-line in the near future. We had a gas vehicle, which would eventually be phased out for the diesel workhorses that held up better to 24 hour constant use, and we enjoyed the occasional backfire which could be mistaken for gunshots. We were a little protective of our vehicle, which technically belonged to the city though we treated it as if it were our own.

I guess you could say that thanks to Eugene, our ambulance was the cleanest in the fleet. Following a Eugene transport, we would spend an exorbitant amount of time hosing down and flooding the patient compartment with every cleaning solution we had on hand. Then, for good measure, we would use our own personal cleaning products for a secondary wipe down. It’s citrus scent made us forget the ammonia produced by Eugene’s overworked kidneys.

We had just finished an extensive clean up of our ambulance from a trauma job when we received the familiar address that let us know Eugene was looking to go to the hospital again. I was working with Quinn, who resolved that something needed to change in our relationship with the passive-aggressive urinator. When we pulled up he immediately began negotiating.

Eugene seemed almost apologetic but it was out of his hands, he told us. When he needed to go, he was going to go. It was almost a Pavlovian response, he tried to explain. He was just used to peeing in ambulances and he didn’t really want to stop. He suggested that, perhaps, he could switch it off with a substantial donation of cash. We checked our pockets but our monetary reserves were a little low for the bribe he was asking for. It looked like we were going to be spending more time soaping up the back with disinfectants.

As Eugene searched through his scattered belongings for his Medicaid card, he told us he wanted to go a particular hospital on the Upper East Side. Despite his lack of electricity, he had managed to become familiar with a new radio advertising campaign for one of the big hospital chains and he felt that it resonated with him. “We go the extra mile for our patients!” they proclaimed. He liked that. The closer hospitals that he usually went to barely went the required mileage, in his opinion. On the East side there was a hospital that was not only standing by for possible customers, this one was asking, no begging, for him personally to come in and be treated by their welcoming staff.

Quinn made a deal to take him there, without the requisite argument about going to the closest 911 receiving, if he could hold his urine in. Eugene reluctantly agreed.

He got in and laid himself down on the stretcher. He wasn’t going to sit on the bench seat for this ride to update his hypertension meds; he wanted the gold star treatment. Quinn was remarkably accommodating. He smiled and even got him a pillow. Pillows were rare commodities in pre-1995 EMS. We were already going the extra mile and we weren’t even a part of that healthcare system.

As I sat in the back with Eugene, I started writing my paperwork for the extended ride to the other side of town. It was probably just an extra six or seven minutes or so but going across Central Park was like leaving your own territory. Things were quiet initially, when I suddenly heard a squelch from the novelty intercom on the wall. I had always felt the intercom was a needless addition to this generation of vehicles. Our truck had big, wide open square between the patient compartment and the cab. You could always hear each other without even raising your voice. But I knew my partner had been itching for an opportunity to use it and here he had found it.

Quinn was a master voice impersonator. Over the intercom he sounded like an elderly woman. “Hello, hello?” he said in his female voice. “Is there a Mr. Eugene on board?”

Hearing his name, Eugene reacted. “What?” he asked. “Is someone talking to me?”

“Yes,” said my partner. “My name is Mary and I work in the kitchen of the Extra Mile Hospital. Have you heard our new slogan?”

“Yes,” said Eugene proudly. “You go the extra mile! That’s why I’m going there. I heard good things about this place.”

“Why thank you, yes!” said ‘Mary’. “We certainly do go the extra mile. Which is why we set up this service to take your meal order while you’re on the way to us, so its hot and ready when you get here.”

“Meal order?” said Eugene. “Is it lunchtime already?”

“Well, almost,” my partner answered in character. “You see, we believe that good nutrition is the hallmark of excellent care. We think that you’ll heal better with nice hot meal in your stomach. That’s part of our new philosophy of going the extra mile.”

“Why ain’t that something?” smiled Eugene. “Other hospitals should do the same thing! How come they’re all not doing it? All the other places are really stingy with the bologna sandwiches. They should be listening to you!”

“Yes, that’s true. Everyone should. But they don’t. But you’re not just getting some cold, dry sandwich. We’d like to set you up with a real hot meal. You’ve got to make a selection and we will present it to you at the ER.”

What the hell was my partner up to? It was genius, I had to admit. I was dying inside at how he had come up with this idea on a whim and here he was, going through the motions, finally making use of that intercom. It was difficult to stifle my laughter but I did as Quinn, as Mary, presented Eugene with several culinary choices. They sounded like descriptions off a high priced menu with random French phrases thrown in that Quinn had been learning in preparation for an upcoming vacation to the City of Light. Eugene could choose from Filet of Sole de Parlez-vous (filet are you speaking), Ah-la-Vache Prime Rib (literally, oh my cow), and Pork Chop au Revoir. Eugene chose the Good-Bye Pork Chops.

“That’s wonderful, sir,” she told him. “It comes with a side of green beans and mashed potatoes. There is a nice red wine reduction added to the gravy and a hint of garlic to the potatoes.”

“That sounds fantastic!” said Eugene. He had such a big smile on his face. I almost felt sorry for this man who had caused me so much disgust and scrubbing related back pain. I was pretty sure he wasn’t going to be getting any kind of meal at his hospital of choice, not even a stale sandwich wrapped in plastic. As someone who’s eating plans have often been interrupted by a dispatchers voice over the radio, I had some empathy for his upcoming plight.

“Ok sir,” Mary told him. “I’ll put that order in. Just remember the order is number E-as-in-Eugene, two, three, four. You got that? E234.”

“I got it!” said an extremely satisfied Eugene. Then he looked at me and said, “See? THAT’S why I wanted to go there.”

All I could do was nod in agreement. This was certainly quite a hospital he thought we were headed to.

We made it to the big hospital on the wealthy side of town and Quinn opened the back doors. As I hopped out, Quinn asked Eugene how he was doing. “I heard you could order lunch here,” he said to him.

“Yes! And I did!” Eugene told him.

Feeding people seemed to be a successful strategy that hospitals should probably look into actually doing. Eugene was already a different person, a pleasant person. He’d probably be an ideal patient for everyone involved, after a nice, hot meal. It seemed to be a small price to pay for a better working environment.

“You’ve got an order number for your meal, don’t you?” my partner asked.

“Yes I do,” said Eugene. “E234. When do I get my food?”

“Good, right after you’re registered, just tell them your number,” said my partner. His tone now turned a shade more serious. A concerned look was on his face. “But I’m going to tell you something. Don’t forget your order number.”

Eugene was all ears.

“The food they cook up here is outstanding. It’s made by chefs with Michelin stars to their name. In fact, it’s so good the staff likes to help themselves to the food. They might even tell you that you’re not entitled to a meal just so they can enjoy it themselves! But you’ve got an order number, right? Don’t you forget it.”

“I won’t!” replied Eugene with all seriousness. “Thank you.”

I was feeling really bad for Eugene until we transferred him over to the hospital stretcher and I noticed he had pee’d on our stretcher, violating the initial agreement.

“I had to. I’m sure you don’t mind. I little extra elbow grease never did any harm to no one. Make sure you clean it real good,” he told me with a big smile when I saw what he had done.

“Enjoy your pork chops,” I told him with a tinge of sarcasm.

“Oh I will,” he told me. “While you’re cleaning up that stretcher.”

Maybe I shouldn’t have taken that much enjoyment in it but I did, especially when we returned with another patient. After leaving the ‘Extra Mile’ Hospital, we had gotten hit with another job very close by and brought the patient back to the same place. We found our previous patient, Eugene, tied to the stretcher he was on. He was screaming mad, yelling at every employee who walked by.

“Look at you! I know you can’t pass by a plate of beautiful pork chops without helping yourself! I know it! You don’t look like someone who could stop themselves from eating even a free bologna sandwich that didn’t belong to you!”

The nurse triaging our present patient gave us a nasty look. “Thanks for bringing that one in,” she told us. “He’s been nothing but abusive and threatening violence on everyone here. Thinks he’s getting fed, a voice named Mary told him, he says. If he keeps this up he’s going to psych.”

“I WANT MY GRAVY WITH THE RED WINE!” we could hear him in the back ground. Everyone could hear him.

“Sorry,” I apologized. “He wanted to come here. He saw your ad.”

The nurse shook her head, “They could have saved us a lot of problems by not sending out advertising. How much did all those billboards and radio ads cost? We’re short-staffed enough without asking for more people to come here.”

I understood her complaint and empathized with her and the rest of the ER that now had to deal with Eugene. She signed my paper and as I was leaving she let me know that Eugene had soiled his stretcher not just once, but two times since we had left. The man certainly had a powerful urinary system.

Manhattan Real Estate

December 29, 2020 /

On the long and diverse list of calls that make it to my “worst” list, one that vividly comes to mind involves the eviction of an elderly couple in Manhattan in the early 1990s. It still causes me immense sadness to remember this older couple haphazardly rummaging around their large two-bedroom apartment in midtown. This was probably the first time I had been called for someone who was being thrown out of their home, but definitely not the last. In the late 80’s and early ’90s, there were several eviction-related jobs I ended up responding to. A city marshal was involved and they often brought along a representative from social services, either Adult Protective Services or another agency. It was this representative who would call EMS.

When we arrived at this home, the door was wide open and we walked in. No one said anything to us except the building super and honestly, it was always the building super on the scene at any of these things, that had any humanity. He was a short, bald man with a Spanish accent who shook his head sadly and directed us to the couple. When we introduced ourselves to the woman she stopped what she was doing and looked up at us in a confused manner. She slowly looked towards the marshal who was busy marking off things on a clipboard. He never looked up but pointed to another man in the apartment. That man wore a lanyard with some sort of official ID and he had a clipboard of his own.

“Oh yeah,” he said when he saw us, as if calling for us had been a quickly forgotten detail. “You’re here for the gentleman. Ah, he has high blood pressure.” In his mind, that was sufficient explanation and he resumed whatever he was doing with his clipboard and walked away. We had been dismissed.

The woman had short brown hair and sad-looking eyes that predated the events of that day, as noted in several of the photos she took off of end tables and dressers to toss into bags they had quickly grabbed and started filling. The man was slim, balding, and wore thick-framed glasses. He seemed a little absent-minded, distracted, and more than a little embarrassed. Neither of them said much to each other as they moved around their apartment for the last time, trying to figure out what, out of 30+ years worth of living in that place, warranted immediate removal.

The couple seemed busy although they moved very slowly. It must have been difficult to prioritize all of their possessions. This had been their apartment since they had gotten married. They raised a daughter here, participated in activities, interacted with neighbors, and held family celebrations in these rooms. Everything they owned was inextricably tied to a lifetime of memories. They had a souvenir from the 1964 Worlds Fair that made it into the suitcase, along with several religious articles of their Jewish faith. A few changes of clothes went in as well.

The man was going through some papers in his desk, trying to figure out which were important and which were receipts he probably could have gotten rid of years before. “Sir,” I asked tentatively. “Are you not feeling well?”

He looked at me like I was out of my mind and I deserved it. Of course he wasn’t feeling well. He didn’t say anything to me for a long time, just continued shuffling through his papers. “Can I take your blood pressure?” I asked. He looked at me with the face of someone who was placating a child but he held out his arm.

His blood pressure was only slightly elevated, nothing unusual, and nothing that required an ER. I asked him if he had any medical problems. He told me only the hypertension. Then he remembered his prescription bottle and went to the kitchen to put it in one of the bags.

The couple continued doing their unorganized pack as if we weren’t there. A fat tabby cat was coerced into a carrier where she howled, fearfully looking at the strangers who had taken over her territory through the mesh of her small container. The woman carried the cat around with her as she looked for things to pack, holding up random items as she considered their importance.

Every once in a while a question was asked by either the husband or the wife and directed toward the marshal. The answer was always some version of ‘no’, with increasing levels of impatience. A defeated look would come over them and they would continue. The marshal seemed very annoyed, almost angry, with the couple. He rarely looked up from whatever important notes he was writing on his clipboard. It appeared that he had a long list of other families to throw out into the street that day and this couple was delaying his schedule.

I do not know the circumstances of that brought about that sad day. Probably, I assume, it was not one big thing but more likely hundreds of little disasters that lined up like inconvenient dominoes leading to that unwelcome knock on their door.

I’m sure the couple had received notices and warnings. Perhaps they were in denial or perhaps they thought they had more time to either fight the eviction or make other plans. Either way, when the marshal had shown up they were unprepared. I understand that evictions happen, that responsibilities need to be met, and that there are consequences for failing to meet them. But to be oblivious to the obvious distress this couple was experiencing was so callous. And the man sent there specifically to assist them couldn’t be bothered to do anything but call 911.

Both the marshal and the social services representative spent the time appearing busy, shuffling papers, and talking on the phone. I have no idea what services were available to the couple or what had been done prior to the eviction. But if there was nothing the social service man had to offer why was he there? I got the impression that he was not working for the couple but for the marshal, to make things easier for the eviction to proceed. The two men seemed to know each other although they did not interact with each other all that much. But when the marshal made a demand of the couple, either to hurry up or deny a request, the social service representative would reiterate what he said in some way, which came off as a supportive measure as if they were united and sometimes it appeared as if they were ganging up on the unfortunate pair, and us when we offered any assistance to the couple that didn’t involve rushing them out the door to our ambulance.

At first, my partner and I just stood around wondering what to do. The last thing we wanted was to interfere with the couple on one of the worst days of their lives. It was obvious the man wanted nothing to do with going to the hospital. We were standing near the man from social services when we started discussing how we were going to RMA [Refuse Medical Assistance]. It was enough to get him off the family’s phone he was using and stop writing on his clipboard.

“He needs to go. They both do. Take them to the hospital.” He tried to dismiss us again, expecting us to just follow his directions. It killed me to do his bidding but at the time we had an age discriminatory rule that he seemed to be exploiting.

Unfortunately, the man was 65, which in those days required us to call our telemetry doctor if he wanted to refuse. It was a terrible, ageist protocol that has thankfully gone the way of leeches and skull boreholes. But at the time we were bound to this archaic rule and the whole service revolved around it. We had been through this routine before with other patients who had reached an arbitrary milestone that rendered them incapable of making decisions that didn’t need to be second-guessed by a doctor. When we called telemetry, we would be asked why the man didn’t want to go. We could say that he didn’t need to, that he never called, that he was just being directed to go to the ER so that they could get him out of the apartment. And the doctor would tell us that it wasn’t our decision to make. When the man presumably got on the phone to speak to the telemetry doctor they would try and convince him to go, because everyone over 65 should have to go. There was a liability issue. The man could argue and they might let him refuse but before that happened there was a likely possibility he could be threatened with a visit from social services if he did so. The same social services agency that was assisting the marshal in kicking him out.

The man from social services started to rush the couple, lest we found the loophole we wanted that would have allowed them to skip the trip to the ER. “Come on, we need to get you to the hospital.” The couple looked at him with bewilderment.

The super stepped in and took the cat carrier from the wife. “I’ll look after Ophelia,” he told her. “And don’t worry, when you’re done at the hospital I’ll let you get the rest of your things.”

The marshal interjected, “Your things will be packed and put into storage. Have your lawyer give us a call and we’ll let you know where you can pick them up.”

The super then offered to put their items in the basement. The marshal told him he was not allowed to do that. The super offered to take some things into his apartment. The marshal now became impatient with the super as well. He spoke slowly, as if trying to reprimand a belligerent child, “You can only take what they give you right now.”

The man from social services stepped in and told the super that wasn’t going to happen because the couple had to go to the hospital right away.

“We can wait,” I yelled out, glad to throw another delay in the way of these two unfeeling individuals. My partner and I offered to help and immediately started putting random items into boxes. We found a crate and filled it with kitchen items. The super put them all in the hallway and called up his wife to take the cat.

Then, after a very short interval, the alarm clock on the marshal’s internal timetable went off and he put a stop to any more last minute packing. “This should have been done weeks ago. Time’s up. Just go to the hospital.”

The couple gave the super some of the bags and a box they had quickly packed. The woman looked around and started to cry.

The husband tried to comfort the wife. All the previous emotions in his face of determination, embarrassment, and confusion gave way to adoration towards this woman. He put his arm around her and looked at the two men who both looked away.

The couple moved slowly to the door, looking around the whole way. It was the last time they would see the home where they had spent their adult life. All the memories they made there would be tainted with this attached experience of being forced out.

The social service man suddenly became very friendly. He handed them his business card and told them to call with any questions or assistance they might need. It was incredibly disingenuous. During the entire time we had been there he had not offered any kind of assistance or made any arrangements on behalf of the couple, except to call EMS to rush them out of their apartment. They were only going to the hospital because he had no other place to offer them. He told the couple to contact the social worker at the hospital who, he assured them, would provide them with a place to stay. He had just passed this couple off for someone else to deal with. His presence on the scene had been as useless as ours was.

I attempted some small talk on the way to the ER but the couple remained silent. I’ll never forget how they just sat together without saying a word to each other.

At the hospital my partner and I asked the registration people about the social workers. They put us in touch with the one on duty and we talked to her about the situation. She became angry, complaining to us that all she could do was refer the couple back to the very same department the man on scene was from. “They pull this crap all the time!” she told us.

I gave her the phone number that I had written down from the business card. She called it up immediately and had a heated discussion with someone from his agency. Then she called the man’s supervisor. In the end she just shook her head and told us the couple was screwed. There was not much she could do for them except refer them to a shelter.

We went with her when she talked to the couple who had been sent to the waiting room. She asked if they had anyone they could call to stay with, she suggested their daughter. The wife started to cry and the husband told the social worker that their daughter had died almost a year earlier.

I have no idea what happened to them after that and I wonder all the time about them. How does someone pick themselves up from that situation? Where do you go from the lowest depths of tragedy to move forward? You would hope that there would be a safety net out there to help people that this happened to.

On many of our calls, we have patients or families in need of far more than we can provide them with, people living in squalor, people in need of counseling, people in need of basic necessities, and it’s often a catchall response for us that they just ‘speak to someone in social services. It’s what we were taught to do as a way to convince someone who doesn’t want to go, to take the ride to the ER (it’s all about getting them to go, I concluded) But now I knew that the advice and recommendation I had been giving had been far more limited than I would have ever thought.

lost places, wall, pforphoto
a palatial mansion compared to where we were

And Somewhere Along the Way, She Was Shot

October 5, 2020 /

This is one of those “worst” jobs.

Trying to find the address the dispatcher sent us to had us searching a desolate, poorly illuminated street. Most of the industrial buildings appeared to have been abandoned but the presence of new gates and security cameras indicated some of them probably were not. It was difficult to locate a number on most of these buildings even using our fancy vehicular spotlight. We asked the dispatcher to verify the address and try the callback for a better location. Our “Unconscious” in bed person didn’t seem to live here, no one did. The area had at least ten more years to go before the first loft apartments would start gentrifying the neighborhood.

Finally a man appeared, seemingly out of nowhere. He was thin, about 50ish, and his stubble was mostly grey. He had become very annoyed by the 911 people calling back over and over again to ask about a location that he felt should have been obvious to find. We told him we would follow him.

He led us down a short alley to the padlocked side entrance of one of the buildings that was, actually, abandoned. There was no way we would have found this patient without a guide. The entire area seemed eerily bleak and unusually quiet. Yet despite our unease, we still followed the strange man for some reason.

The man showed us a large hole in the wall that had once been a window and pointed to where the patient was. We shined our two flashlights into the darkness. A large figure lay on what could hardly be considered a “bed”. It had possibly once been a mattress but now it had completely become one with whatever the floor was.

“Is this the only way in?” we asked. The man nodded. We looked at each other with a smile as we shined our flashlights around the entire space contained behind the ‘window’. Many rodents scattered. The area was filled with garbage, so much garbage. There were extra piles of garbage on top of the floor which was covered in garbage. We had more than a few safety concerns. We looked at the ceiling to see if it would hold for the duration of time we would possibly be in there for. It’s not like we know anything about building construction but I thought it would hold. There weren’t any other people around, except for the inconvenienced man and the individual on the other side of the room.

My partner nodded over to the person on the ‘mattress’. “What’s going on with that one over there?” he asked.

“I can’t wake her up!” he said. The man went on to explain that he had found the woman, who he was familiar with and called “Flo”, on what he called his bed. He wasn’t really sure what her real name was. They had had “relations” and then afterwards they shared some drugs and took a nap. Now he wanted her to leave. This was his hangout and she was only a visitor, in his telling of it. He tried rousing her but she never responded.

One after another, we athletically hopped up to sit on the open window ledge. We swung our legs around to the other side of the opening and shined our lights below us before hopping down. Every step we took was done carefully as we made our way over to the woman. The floor was littered with drug paraphernalia and the air smelled of death and every kind of rot imaginable.

The woman was completely naked. She was initially on her side and when we turned her over we discovered that she was pregnant. My partner and I exchanged the first of many knowing glances toward each other, glances that we could easily interpret despite the darkness of this filthy area.

Her pupils were pinpoint and her breathing was slow and irregular. “How much did she have?” I asked her companion.

The man had no idea. It turned out that when he said they had ‘shared’ drugs what he really meant was that he had shared her drugs with himself. Whatever she had taken, she had taken it before he found her. It became clear he had had “relations” with the woman while she was in this unconscious state. I was even more disgusted.

We asked him where her clothes were and he said he didn’t know. He had found her like that and taken it as an invitation. He had found a needle in her foot and without knowing what was in it, used what was left on himself. There was nothing unusual about any of this, in his world. He had no idea how long ago that was because, as he told us, he doesn’t wear a watch. He was just a free spirit.

We hit the woman with some naloxone (Narcan) and gave her oxygen in the hope it would reverse whatever chemicals she had shot into her foot. But even though her breathing got a little better it did nothing to change her unconscious status. We started ventilating her with our BVM (bag-valve-mask) and called for EMT back up to assist us.

“I’m not really into working her up in this hell hole,” my partner said to me. The man became somewhat confused and visibly insulted. What hell hole? This spacious warehouse loft that smells of death? Why, in a decade or so hipsters will be paying thousands of dollars for this place that he now lives in for free.

But we opened the drug bag to see what we could accomplish until the BLS got there to help us get her out. We needed multiple little pads of alcohol to swab her arms clean while searching for a vein to stick, which was a monumental endeavor since most of them had been destroyed from years of injecting chemicals into them with unsterilized needles. I’m going to pat ourselves on the back for the success in getting this difficult IV in the darkness, illuminated only by shaky flashlights that don’t have the LED capability they have now, in modern times.

My low lumens flashlight is the EMS version of I walked 5 miles to school in the snow.

While running the flashlight up and down her limbs in search of a usable vein we noted an injury to her upper left shoulder. It looked like a bullet hole. The man knew nothing about it and was as surprised as we were.

We heard the sirens of our back up and we sent the man out to show them how to find us. In the meantime we gave “Flo” more naloxone, to no avail. This certainly wasn’t just an overdose. Whatever she had taken had also been injected into the arm of our guide and it didn’t seem to be affecting him as profoundly, although she certainly could have taken significantly more.

As our EMTs made their way through the ‘window’ we yelled across the abandoned room for them to be careful, as if they couldn’t see for themselves the danger inside. I loved them for having brought a hospital sheet with them, as so many don’t. It would be a tremendous help in moving her since she had no clothes to grab on to. The crew moved right to the top of my most favorite EMT list when they noted our nice clean IV with admiration.

“Where’s her rapist?” I asked.

“Oh, I don’t know. He pointed to where you guys were and he took off and left,” one of them told us. He looked at the patient. “Wait, is she pregnant?”

“Yes, and it looks like she’s been shot as well,” said my partner. This was like one of the ‘mega-codes’ we train on at the academy, except they usually just stick to either trauma OR medical, not both at the same time.

As we balanced ourselves on top of piles of garbage we managed to get our patient onto a carrying device so we could get her out. We then slowly made our way over to the hole in the wall, stepping over crack pipes and needles, every kind of trash, and the long dead corpses of rodents who did not survive. We luckily made it without falling. We then carefully passed our patient through the hole in the wall onto an awaiting stretcher.

I was never so grateful to make it to the clean, controlled environment of our ambulance. We could finally make a better assessment of our patient. But taking a good look at our patient made me incredibly sad. This woman’s body told the story of a hard and rough life. What kind of messed up circumstances had this woman lived under, what stories could she tell? She was a tall woman who looked to be in her forties, although that was purely a guess. She had scars everywhere. There were track marks where I never thought there would be track marks. She was missing most of her teeth and her nails were either really long or gone altogether.

Her gunshot wound had a clear entrance and exit wound but did not seem to be causing any significant bleeding. We would probably be going to a trauma center even though the gunshot was the least of her issues at the moment. Her vital signs remained fairly stable. Since we didn’t know the onset of the symptoms, of what appeared to be a stroke, going to a ‘stroke center’ would not have been useful. There is a definite timeline that stroke procedures require and we had no way of knowing when everything started.

We intubated her and hooked her up to our monitor. She seemed to be slightly responsive to painful stimuli, which was a good step in the right direction.

“Umm, guys,” said one of the EMT’s tugging at my shirt. “I think the baby might be coming.” He was noting what appeared to be water breakage on a particular area of the sheet covering her.

I’m sure we all looked similarly terrified. An OB kit was pulled from the cabinet and more sheets were utilized, just in case.

What kind of notification would we be giving?

We tried to give the basics to prepare the trauma center without being too long winded. If we told the whole story we would be at the hospital by the time we were finished. We tried to downplay the gunshot but that’s all you have to hear for it to make it to the top of the interest hierarchy. We were also requesting that an incubator be standing by.

It was mayhem inside the hospital. Thanks to our notification dozens of trauma related people were standing by along with others not sure why they had been summoned for a gunshot notification. I guess when you hear that a patient has a gunshot wound all the other information gets drowned out. You could tell they were gearing up to get mad about something. And nobody listens to the whole synopsis.

There were so many people throwing out questions at us from all directions. We tried very hard to tell our patient’s story in one cohesive storyline but it kept getting interrupted by questions we had no answers to. Didn’t you give naloxone? Why isn’t she breathing on her own? How many months along was she? How long ago did the gunshot happen? Where are the police? What kind of medical history does she have? What did she take? Did you give the naloxone? Why did you take off all her clothes? Does she take any medications? What’s that smell? Is this her first pregnancy? Did the father come along? Is there any weakness on a particular side? Did she say anything? What kind of gun was it? She’s obviously on something, why didn’t you give naloxone?…

This seemed to be a hospital far too comfortable with having everything taken care of beforehand. Had they never gotten a patient before that didn’t arrive with a complete medical history? They continued with their demands for answers we didn’t have and they never stopped bringing up naloxone, as if we hadn’t already given her our entire protocols worth. I was starting to get annoyed at all of them in their nice clean environment. They didn’t have to step over crackpipes and rotting fast food to get to their patient. They didn’t have to contort their body into a small width of space between the captains chair and the back of the stretcher in order to insert a tube down the patient’s throat. They didn’t have to hold their breath for minutes at a time to deal with the overwhelming stench of different things dying and decaying at different rates around them . I doubt they could have gotten an IV the way we had. Was anyone even noting the stroke that we had given as the first priority of our notification?

The EMTs and I were feeling a little overwhelmed when my partner used his charm and wit to put some perspective into the hoard of questioners and complainers.

“Look,” he yelled, surrounded by the angry faces of a crowd demanding answers. “She was found in a garbage dump. The only person with her told us that he fucked her and then stole her needle and ran off somewhere. That’s all the information we were given, now it’s all the information you have. And somewhere along the way the woman was shot.”

We brought another trauma patient to that hospital a few hours later. It was somewhat insulting and also somewhat useful that no one seemed to remember us at all. It was a different nurse doing triage and she apologized for a delay in finding us a stretcher. “You’re not going to believe this but some EMS crew brought in this lady who having a stroke, and she was shot too. AND she had a baby in the ER! Can you believe it? They delivered a baby in the ER!”

“That IS crazy!” I replied.

“They were going out of their minds around here when I came in. And the OB floor took their time sending down an obstetrician so an ER doctor had to do it. They were lucky it wasn’t a C-section.”

I found out that is extremely rare for comatose women to give birth unassisted but our patient had, for the most part. No one had to tell her to push and no one had to do an epidural. She delivered a small, underweight baby girl who had a long road ahead of medical treatments.

The incompetent EMS people who brought her in had not provided any of the necessary information, such as the number of pregnancies she had previously, when her due date was, where she was getting her prenatal care, none of it.

“I guess you had to ask the patient herself, then,” I surmised.

“How could we do that?” she looked at me like I was crazy. “The woman was unconscious. She couldn’t tell us anything.”

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